| NPI | 1518255397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301015537) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1315) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2021-09-30 |